Doctors aren't offering cholesterol drugs to all eligible patients

(Reuters Health) - Roughly one-fourth of U.S. adults who fit the criteria to be on cholesterol-lowering drugs don’t take them, often because doctors don’t offer them or patients worry about side effects, a new study suggests.

Researchers surveyed 5,693 adults who were eligible under current guidelines to take statin drugs. Statins help reduce blood levels of low-density lipoprotein (LDL) - the bad kind of cholesterol that builds up in blood vessels and can lead to blood clots and heart attacks.

Overall, about 27 percent of survey participants were not taking statins even though treatment guidelines say they should be.

Roughly 59 percent of people who weren’t taking statins said their doctor never offered them a prescription. This was more common among women, black people and uninsured patients.

About 10 percent of patients who weren’t taking statins had declined to take the drugs when their doctor recommended it, and another 31 percent stopped taking the pills, often because of concerns about side effects. Severe muscle aches are a side effect of statins, previous research has found.

“However, many patients reported fearing side effects that are not caused by statins,” like memory loss, said lead study author Dr. Corey Bradley of Duke University Medical Center in Durham, North Carolina.

“We also know from other studies that many patients who experience side effects on statins are experiencing the ‘nocebo’ effect - where fear of the side effect leads a patient to perceive it, even if it’s not biologically real,” Bradley said by email.

“This is why we see so many muscle aches in the placebo arm of statin clinical trials,” Bradley added. “The reality is that statins are one of the most studied, most effective, and safest medications we have to prevent heart disease.”

In 2013, U.S. cardiology groups recommended expanding use of statins to include certain people without a history of heart disease who had some signs they might be at risk for complications like heart attacks in the future - including obesity, smoking, high blood pressure, diabetes, high cholesterol and older age.

While about 70 percent of patients taking statins in the study thought the drugs were safe, only about 37 percent of people who declined the drugs or discontinued use felt that way, researchers report in the Journal of the American Heart Association.

At the same time, about two-thirds of people who said their doctor had never recommended statins said they would be willing to try the drugs. And 60 percent of people who discontinued statin use said they would be willing to try again if their doctor recommended it to them.

Because the study was based on a survey, it’s possible some patients said their doctors never discussed statins because they forgot these conversations and not because the drugs weren’t recommended, Dr. Robert Eckel, a researcher at the University of Colorado School of Medicine in Aurora who wasn’t involved in the study, said by email.

Still, the results suggest that many patients really are missing out on statins because their doctors didn’t prescribe the drugs, said Dr. Ian Kronish, associate director of the Center for Behavioral Cardiovascular Health at Columbia University Irving Medical Center in New York City.

Some doctors may not have been fully behind the major changes to statin recommendations in 2013, particularly for the new subset of patients who didn’t have dangerously high cholesterol levels but now qualify for the drugs based on risk assessments for future cardiovascular disease, Kronish said by email.

“It could have been that doctors were uncertain as to whether statins were really needed,” Kronish said.

When doctors don’t mention statins, patients should ask, and not assume they don’t need the drugs just because the conversation never happens, Kronish advised.

Kronish also recommended that patients check online tools like the one offered by the Mayo Clinic (here: mayocl.in/2pCqY3J) to see if they might benefit from statins.

SOURCE: bit.ly/2FK27UV Journal of the American Heart Association, online March 27, 2019.